References

Dudley and Walsall Mental Health Partnership NHS Trust. Understanding what your named nurse can do for you. 2016. https://tinyurl.com/y8xc56q8 (accessed 17 January 2019)

Katikireddi SV, Cloud GC. Planning a patient's discharge from hospital. BMJ. 2008; 337 https://doi.org/10.1136/bmj.a2694

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When a person with dementia is leaving hospital

24 January 2019
Regulars
02 January 2019
Volume 28 · Issue 2

Abstract

People with dementia can find change particularly difficult. Aysha Mendes looks at how to minimise distress experienced by these patients when they leave the ward to return home or move to a new care setting

Changes in routine for a person with dementia can be highly distressing. If a person moves during a hospital stay, whether from ward to ward or within one ward, it is likely staff will experience what feels like ‘challenging behaviour’ as the person tries to express anxiety and distress (NHS Education for Scotland (NHSES), 2011).

It may be that staff have made every effort to minimise moves and disruption, and the person has settled into a routine on the ward. However, routine will be shaken up again when it is time to discharge the person home or to a care home if their functional ability has changed since admission (NHSES, 2011). Regardless of the situation, discharge requires planning, preparation and a gentle approach. Nurses have a vital role in making people with dementia feel secure in hospital, ensuring they are recognised, listened to and communicated with throughout their stay. Facilitating a smooth transition is important for every patient; however, for a person with dementia, a little extra attention is required to minimise the stress that can arise from the combination of changes to the environment and the features of their condition.

Moves within and outside the ward should be kept to a minimum and, if required, should be undertaken with the interests of the person considered first. Every effort should be made for moves to take place during the day, late morning if possible (NHSES, 2011). Before any move, family and carers should be fully informed and given the opportunity to be involved and help if they wish (NHSES, 2011). The benefits of named nurses are widely acknowledged (Royal College of Nursing, 2015; Dudley and Walsall Mental Health Partnership NHS Trust, 2016). One named staff member should be responsible for ensuring everyone is kept informed and updated (NHSES, 2011).

Where a person is going to a new setting such as a care home, a named professional should be assigned and their details should be shared with the patient's family, carers and any professionals involved (NHSES, 2011). Older persons' mental health liaison services should be involved where available (NHSES, 2011). If the person does not have a carer, involving an independent advocate should be considered (NHSES, 2011).

Discharge planning

Planning the discharge should start on admission and involve the multidisciplinary team, the family and carer and, importantly, the person themselves (NHSES, 2011). The key aims of discharge planning are:

  • To improve the preparation and coordination of care and services
  • To identify potential problems or obstacles to discharge and plan solutions (Katikireddi and Cloud, 2008; NHSES, 2011).

    • Thus, referrals to key services, such as physio- or occupational therapy, should be made as part of discharge planning, (NHSES, 2011).

    When a person is being discharged, a comprehensive multidisciplinary assessment is essential (NHSES, 2011). Local discharge checklists will vary, but issues to consider include:

  • The person's attitudes and wishes: what do they want and what services are required?
  • Family input on these attitudes and wishes: what do they want, how do they perceive their role and what support do they need?
  • Personal care: what level and type of care is provided, are changes needed and how will it be arranged, provided, monitored and reviewed?
  • Accommodation: has the home been assessed for how suitable it is and are modifications required?
  • Mobility: this is part of home assessment, and includes adaptations and equipment
  • Food provision and preparation: who will be responsible for food shopping, preparation and assistance with feeding, if required?
  • Medication organisation and compliance: who will be responsible for ordering, collecting and supporting the administration of medication? Have the main carers received medication education?
  • Finances: how will care be paid for and who will help with managing finances?
  • Sleep: has the person's sleep pattern altered and how will this be managed?
  • Wandering: what risks exist around the person wandering and getting lost? How will this be managed safely?
  • Weekly structure/social outlets: how will the person (family/carer) access social interaction?
  • Vulnerability and risk of exploitation: these should be considered and planned for (NHSES, 2011).

    • Conclusion

    After a hospital stay, a person's functional ability and care needs may change. Every effort should be made to return the person to their home, rather than an alternative care setting, and technologies are available to support this. These include personal wearable GPS tracking devices, such as pendants, bracelets, watches and even insoles (Mendes, 2015).

    The highest quality of care possible should be facilitated, and the ability of the carer to care for the person in their home should be supported for as long as is practical, safe and fulfilling for both patient and carer. Support must be given and referrals made to help the person readjust to living as normal a life as possible at home or the new care setting after discharge.